The main purpose of this study was to explore, analyze and reflect on the meaning, nature, causes and associated dynamics of change in higher education within a Pakistani cultural context. Resistance was a major component of understanding this change. I focused on multiple factors that induced individual/group tendencies to resist or avoid making changes and to devalue change generally. This study employed a multiple case study approach. Semi-structured interviews with designated stakeholders of the planned change initiative were the primary data-collection method. Document analysis, members check and observations were used to triangulate the interview data. The data were analyzed on an ongoing basis. The findings revealed the complex dimensions of participants’ compliance and/or resistance with respect to change at the beginning of the twenty-first century when the Pakistani higher education system was shifting dramatically from a local to global perspective. Despite serious issues and weaknesses, change was gradual over time and the most strongly contested reforms were those that did not align with existing practices. In sum, the findings support the notion that change is complicated, and that the reasons for this complexity stem from factors that are structural, emotional, political and personal. The results of this study will be of interest to administrators and educators as they prepare for future challenges within the Pakistani context. The theoretical and practical implications of these findings are discussed, and directions for future research are identified.

Purpose: To examine stakeholder participation in the primary care system change process that led to the introduction of the first Nurse Practitioner-Led Clinic in Ontario. Design: Qualitative case study guided by the principles of stakeholder and system change theory. Setting: Northern Community in Ontario, Canada. Participants: Purposeful sample of healthcare providers, healthcare managers and health policy stakeholders. Procedures: This case study was bound by place (Sudbury), time (January 2006–January 2008), activity (stakeholder participation), and process (introduction of an innovation, the first Nurse Practitioner-Led Clinic in Ontario, during a primary care system change). Semi-structured individual interviews were conducted with participants who represented the clinic, the local community, and the province. Public documents, such as newspaper articles published during the 2 year time boundary for this case and professional healthcare organization publications, were also examined. Interviews were analyzed using qualitative content analysis and public documents were reviewed for key messages to complement the interview findings. Field notes written during data collection and analysis were used to provide additional depth, contribute insights to the data, and ascribe meaning to the results. Main Findings: Sixteen interviews were conducted with key stakeholders. Twenty public documents which yielded the most specific information relevant to the case study time boundaries and activities were selected and reviewed. Six main themes are reported: felt need, two visions for change (one for a Nurse Practitioner-Led Clinic and one for Family Health Teams [FHTs]), vision processes related to ensuring the visions became or continued to be a reality in Ontario’s healthcare system (shaping, sharing, and protecting the vision), stakeholder activities, and sustaining and spreading the vision. Conclusions: In this case, stakeholder participation influenced policy decisions and was a key contributor to the primary care system change process to introduce the first Nurse Practitioner-Led Clinic in Ontario. Stakeholders are motivated by various needs to engage in activities to introduce an innovation in primary care. One of the most common needs felt by both those who supported the introduction of the first Nurse Practitioner-Led Clinic and those who were opposed to it was the need for improved patient access to primary care.

The purpose of this research was to develop and evaluate a 5-week readiness for change precursor to group cognitive-behavioral therapy for individuals with eating disorders. Group content was based on the theories of the Transtheoretical Model of Change and Motivational Interviewing, and also included an experiential pretraining component. Forty-six medically stable individuals with anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified (EDNOS) were recruited from the Adult Eating Disorders Program at the Health Sciences Centre in Winnipeg, Canada. Participants completed measures of readiness for change, eating disorder symptomatology, and treatment outcome at three time points: pre- and post-readiness precursor, and post-cognitive-behavioral group. One-way repeated measures analysis of variance, regression analysis, and Cochran’s Q analysis were used to investigate hypotheses. Results revealed that participants’ readiness for change increased significantly following the readiness group. However, despite changes in readiness, stage of change awareness and cognitive-behavioral treatment drop-out rates were not significantly improved. In was concluded that motivational interventions appear to be an effective way to increase readiness for change in the eating disorders, however more research is needed to determine whether increases in readiness have a significant impact on treatment outcome.

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This research aims to contribute to a better understanding of the small firm sector’s role in bringing about employment growth at the community level. The study begins by focusing on the new prominence of the small firm and the reasons for this. Part of this new prominence relates to the apparent ability of the small firm sector to generate a disproportionately large number of jobs when compared to the large firm sector. This ability has in turn led to speculation that small firms could play an important role in regional development. However, the literature reporting on small firms and the literature reporting on changes in the economy send mixed signals with respect to the potential of the small firm sector as an instrument of regional development. As a result, it is relevant to ask whether small firms can lead recovery in communities recently depleted by above average employment losses. In seeking an answer to this question the research focuses on Great Britain. There are several reasons for this choice. First, since the 1980s many researchers in Great Britain have studied the small firm sector; as a result, there is a substantial knowledge base including a sound understanding of the environmental factors that influence rates of new firm formation. Second, Great Britain has simultaneously experienced both growth and decline as its regional economies exhibit substantial variation; consequently, issues of regional development are important there. Third, during the 1980s the new prominence of the small firm received a considerable boost from promotion of the enterprise culture by successive Thatcher governments. Fourth, Great Britain’s small firm sector exhibited exceptional growth over the 1980s when the population of VAT registered firms increased substantially. Therefore the British experience should be an important indicator , of the potential of the small firm sector to lead recovery. Using the NOMIS data base and other sources, each community in Great Britain was classified as occupying an environment that was either most conducive, least conducive or indeterminate with respect to its influence on the rate of new firm formation. It was then shown that the majority of depleted communities in Great Britain occupied environments that were among the least conducive to new firm formation. Consequently, for the majority of Britain’s depleted communities, small firm led recovery would require a robust small firm sector that was capable of overcoming the limitations imposed by unfavorable environmental conditions. The research also showed that in recovering communities there was virtually no association between rates of firm formation and rates of net FTE employment change. This result strongly suggests that many recovering communities relied on other sources of employment change for their recoveries. An analysis of employment changes in recovering and non- recovering depleted communities revealed the very important role played by the manufacturing sector. In recovering communities the manufacturing sector acted as a "stabilizer" which made it possible for the contributions of new small firms to be observed. Together these findings suggest that in communities experiencing substantial losses m manufacturing employment, government policies which are intended to stimulate recovery by emphasizing entrepreneurship would be more effective if at least some resources were directed toward stabilizing employment in the manufacturing sector. In other words, even though new small firms created many new jobs, differences between depleted communities that recovered and depleted communities that did not recover are not well explained by variations in the number of jobs created by new small firms. Rather, the differences appear to be better accounted for by the abatement of manufacturing job losses in some communities (those that recovered) and the continuation of manufacturing job losses in others (those that did not recover)

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